Bilateral Hydrophilic Acrylic Intraocular Lens Opacification Occurring Sequentially After Ahmed Valve Implantation

Purpose: To report a case of sequential hydrophilic acrylic intraocular lens (IOL) opacification in both eyes following Ahmed valve implantation in a patient with neovascular glaucoma secondary to diabetes.Case summary: A 59-year-old man was referred to our clinic with ocular pain and elevated intraocular pressure (IOP) three months after undergoing bilateral cataract surgery with hydrophilic acrylic IOL implantation. Examination revealed bilateral proliferative diabetic retinopathy and neovascularization of the iris and anterior chamber angle. The IOP measured 24 mmHg in the right eye and 57 mmHg in the left eye. The patient was diagnosed with neovascular glaucoma secondary to diabetes. Due to uncontrolled IOP, Ahmed valve implantation was initially performed in the left eye. Two years later, the patient experienced decreased visual acuity in the left eye, and a round central opacification of the IOL optic was noted. The opacified IOL was explanted, and a new IOL was implanted with scleral fixation. During follow-up, Ahmed valve implantation was also required in the right eye due to progression of neovascular glaucoma. Two years postoperatively, similar pattern of IOL opacification was observed in the right eye, necessitating the same surgical management.Conclusions: Hydrophilic acrylic IOL opacification may occur following Ahmed valve implantation, and is potentially related to altered aqueous humor dynamics, pH changes, and chronic inflammatory responses.